Volume 5, Issue 1,
January 2013

Social accountability is about ensuring greater equity in the delivery of services to communities, especially those that are poor and marginalised. A World Bank discussion document suggests that social accountability is manifested most strongly where there is good governance and an empowered community, which ultimately results in the increased effectiveness of developmental initiatives.

Background. Evidence-based practice (EBP) is the process by which a clinician evaluates the quality of evidence before applying it in the management of a patient. Many practitioners struggle to integrate this research-based evidence into their professional practice. Blogs have been identified as useful pedagogical tools that can facilitate the sharing of ideas and clinical experiences among peers to reflect on diverse learning experiences.

Objectives. A qualitative research design was used to examine the use of reflective blogging to teach the process of EBP in physiotherapy.
Methods. A conveniently selected group of postgraduate students who were registered for an EBP module participated in the study. Blogging was used to teach the process of EBP in physiotherapy using Kolb's cycle as a guiding and an evaluative framework. Students reflected on and shared their learning experiences in ways that exposed the limits of their understanding around certain concepts.
Results. The results reflect how students moved from assisted to independent performance by identifying gaps in their own understanding and finding the answers themselves.
Conclusion. Reflective blogging was found to be a valuable tool for promoting meaningful learning activities among participants and assisted students in making sense of their shared experiences. It was also an effective tool to be used in teaching the process of EBP.

Background. In 2007, a Supervision Course in Undergraduate Clinical Supervision was developed at the Faculty of Medicine and Health Sciences at Stellenbosch University in South Africa. The target group was inter-professional clinical educators that are involved in student education on the clinical platform. Although the course participants were professionals and specialists in their own fields, the majority of clinical educators have very little or no knowledge of adult education. The Supervision Course aims to develop clinical supervision skills of clinical educators by exposing these supervisors to basic principles of education and specifically clinical teaching, resulting in quality education for undergraduate students. The aim of this study was to determine the impact of this short course on the personal and professional growth of the clinical educator.

Methods. A qualitative study was performed, including an open-ended questionnaire that provided opportunity for the clinical educators to elaborate freely on their strengths, weaknesses and areas of desired improvement before and after the Supervision Course, and a semi-structured individual interview after the Supervision Course. The questionnaire data were categorised according to strengths, weaknesses and areas of desired improvement. An inductive approach was used to analyse the qualitative data. Key themes that emerged from the interviews were identified and grouped together in categories.
Results. The results are summarised in table format to identify themes with supporting quotes.
Conclusion. Although a small sample, this study demonstrates the personal and professional growth reported by attendees of a clinical supervision short course.

Context and setting. Academics face difficulties when trying to include public health in the medical curriculum. The first hurdle is an already overloaded curriculum and the second the marginal interest in the healthy on the part of those who are mainly concerned with the ill. One overlooked potential opportunity for inclusion in the curriculum is the elective and, in particular, the self-constructed elective of third-year medical students at the University of Pretoria.

Why the idea was necessary. Not only does public health have to compete with the powerful clinical interests among students, but students are also not in a position to identify opportunities in the community that could offer meaningful learning opportunities for an elective in public health.
What was done. An action research study design used an online survey to explore the factors that students take into account when constructing an elective experience. These factors determined the final design of a public health elective which was subsequently advertised to third-year medical students at the University of Pretoria as a possible option.
Results and impact. Disappointingly, no student enrolled for the elective. Subsequent investigation of students' actual choices resulted in a deeper understanding of students' unvoiced needs. It would appear that a successful public health elective needs to be like a mini-skirt - long enough to cover the subject, but short enough to hold interest. Academics considering innovations in public health could benefit from this complexity in design.

Background. Limitations in physiotherapy curricula have been reported. Work-based experiences, especially during compulsory community service, could inform curricula.

Objective. To develop a model of community service physiotherapy to guide curriculum reform.
Methods. In this appreciative inquiry, trained physiotherapy students conducted tele-interviews with newly graduated physiotherapists. Twelve recently graduated community-service physiotherapists - heterogeneous in gender, mother tongue, university attended and work setting - were purposively recruited. Two coders applied Tesch's coding technique to the transcripts; one did paper-based work and the other used AtlasTi software. Consensus was reached and a member check done.
Results. Four themes identified were: (i) the essence of community physiotherapy; (ii) the collaborative nature of community physiotherapy; (iii) prerequisites for a positive practice environment; and (iv) community physiotherapy as a gateway to personal growth and professional development. Physiotherapists consult clients from varied cultural backgrounds, ages and health and disease profiles. Health education is a key intervention, but clients emphasised therapeutic touch. Team work enhances services, especially within a context of poverty, and prevents isolation. New graduates have to deal with inefficient management, lack of transport, inadequate equipment and needs resilience. They want discipline-specific supervision.
Conclusion. Community physiotherapy makes specific demands, especially for novice therapists. Service-learning in authentic diverse contexts would foster professional development and cultural competence. Clinical competency should remain the backbone of the curriculum, complemented by competency in health education. Different ways of reflection would facilitate lifelong learning and growth in attributes such as resilience, which is necessary for dealing with sub-optimal practice environments.

Background. Recent evaluation of the Interdisciplinary Health Promotion (IHP) course offered by the University of the Western Cape (UWC) at schools revealed that the needs expressed by the schools had not changed in the last five years.

Objectives. This paper describes the process that was undertaken to identify specific interventions that would have an impact on the schools and, in turn, the broader community, and provides an overview of the interventions conducted in 2011 - 2012.
Methods. A stakeholder dialogue explored notions of partnership between the university and the schools, sustainability of health promotion programmes in the schools, and social responsiveness of the university. An action research design was followed using the nominal group technique to gain consensus among the stakeholders as to which interventions are needed, most appropriate and sustainable.
Results. A comprehensive plan of action for promoting health in schools was formulated and implemented based on the outcome of the stakeholder dialogue.
Conclusion. The study's findings reiterate that an ongoing dialogue between schools and higher education institutions is imperative in building sustainable partnerships to respond to health promotion needs of the school community.

Background. Health professions training is undergoing major innovative changes aimed at improving the quality of health professionals. Unfortunately many of these innovative changes in training have met resistance from lecturers and students simply because they are just imposed on them. One way of ensuring acceptability and success of innovative and evidence-based training methods in health sciences could be the use of participatory action research approaches.

Objectives. To explore the experiences of students and lecturers as well as identify potential benefits regarding the use of a participatory action research approach in a real learning context.
Methods. This was an action research study using a participatory approach.
Research findings. Participants reported satisfaction with the action research process and said it was a valuable learning experience. Key benefits of participatory action research identified included: empowering and actively engaging participants, combination of scholarly work, learning and immediate action, promotion of collaborative inquiry and team-work in initiating changes in training.
Conclusion. Participatory action research has the potential to result in acceptable and sustainable educational innovations because it involves the active involvement of all stakeholders affected by these interventions.

Background. The University of the Witwatersrand introduced a new curriculum in 2003 where students could gain admission to the medical programme at two levels: directly as school leavers or following a degree as graduate entrants at the third year of study. From this point both groups of students continue in a combined class in a single curriculum.

Objective. To determine the experiences of the fifth cohort of graduating students from a medical programme following curricular transformation.
Method. A quantitative descriptive study was undertaken using a semi-structured questionnaire with both open- and closed-ended questions. There were 201 students in the graduating class, all of whom were invited to complete the questionnaire.
Results. A 74% response rate was obtained, of which 66% were school leaver entrants and 34% were graduates. Among the best experiences there were 59 comments relating directly to the programme. The worst experiences included perceptions of the lack of standardisation in clinical exams and feelings of inadequacy in relation to pharmacology and microbiology. Just under three-quarters of the participants felt 'adequately prepared' for the clinical years; 82% of the participants stated that they would make changes to the programme.
Conclusion. The placement of this evaluation at the conclusion of formal assessments may have contributed to the depth of responses and openness of respondents in the completion of the questionnaire. We highly recommend the value of obtaining data on students' experiences and opinions of a programme at the point of exit from the programme.

Background. Currently, clinicians who move into academia may not have the necessary skills for this transition. Given that most health professionals are socialised into their professional roles as clinicians, the shift to academia requires a second socialisation into the academic role. There is a body of existing research that suggests that the transition for clinicians as they become lecturers in higher education is challenging.

Aim. This study aimed to determine the subjective experiences of young academics in their transition from clinicians to clinical educators/academics. In particular, participants were asked to identify the factors that acted as facilitators or barriers to their transition from clinician to academic.
Methods. The study employed a phenomenological framework. Participants (N=7) were a group of clinical educators/lecturers involved with undergraduate students at an identified institution. Unstructured interviews were conducted. Following each interview, audio-recordings were transcribed verbatim and all data were anonymised. Data were analysed manually by each author and consensus was reached on the identified themes.
Results. The mean age of participants was 31 years, with an average of 8.4 years of clinical experience and 3.4 years of academic/clinical education experience. The transition experience from clinician to academic is discussed according to two themes, i.e. intrinsic factors (confidence, competence, personality, and ability to draw on personal experience) and extrinsic factors (supportive environment, peer relationships, mentoring, understanding institutional rules and regulations).
Conclusion. The findings identified both intrinsic and extrinsic factors that may facilitate or hinder the transition process. Intrinsic factors such as uncertainty and personality influences or extrinsic factors such as supportive environments can interact to thwart the adjustment or transition of new staff. Despite individual differences, there is an essence to the experience of the adjustment to academic, as evidenced by the reaching of saturation in a relatively small sample. Based on the results, it is evident that there is a clear need for staff development initiatives related to internal motivation of the individual and supportive extrinsic factors to successfully make the transition to clinical education.

Introduction. Educating students in a multi-cultural society is a challenge as teachers, students and the community they serve all tend to represent various social groups. Skills alone are not adequate for competency in understanding cultural aspects of consultations. A combination of knowledge, skills and attitude is the most widely accepted current approach to teaching culturally competent communication to medical students. Collaborative reflection on narratives of experienced clinicians' cultural encounters served to construct an understanding of how to develop these attributes.

Process. An interest group of medical teachers met to address the specific needs of teaching a relevant cross-cultural curriculum. Participants offered narratives from their professional life and reflected on these encounters to understand how to improve the current curriculum to better address the needs of the students and patients they serve.
Results. Through narratives, participants were able to reflect on how their experience had allowed them to develop cultural awareness. All stories represented how attitudes of respect, curiosity and unconditional positive regard were held above all else. The process of collaborative reflection with peers unpacked the complexity and potential in the stories and different learning opportunities were discovered. Learning was personalised because the stories were based on real experiences.
Conclusion. The use of collaborative reflection on narratives of clinical encounters could facilitate insights about cultural aspects of medical practice. Elements such as curiosity, respect and unconditional positive regard are illustrated in a unique way that allows students to appreciate the real-life aspects of cross-cultural clinical encounters.

In Ethiopia, clinical laboratory education started in 1954 at the Pasteur Institute (Institute de Pasteur), which is now the School of Medical Laboratory Sciences in Addis Ababa University College of Health Sciences. The school offers BSc and Masters programmes in Clinical Laboratory Sciences. This project was implemented in the undergraduate programme.